Senate Republicans are making one last desperation push to repeal Obamacare but face significant challenges to get it done before a final deadline at the end of the month.

A number of Republicans are jumping on board a proposal by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana to replace the Affordable Care Act’s insurance subsidies with block grants to states, which would decide how to help people get health coverage. But some of the same GOP senators who blocked various stages of earlier repeal efforts are withholding their support. Two months ago, Majority Leader Mitch McConnell’s effort to pass a replacement with only Republican support suffered a spectacular defeat in the Senate. When members of the Senate health committee then began working on a bipartisan plan to shore up Obamacare, Graham and Cassidy revved up a new bid to get their GOP-only bill to the Senate floor.Democrats are warning that the bill is a serious threat.

"This is not a drill," Senate Democratic leader Chuck Schumer of New York wrote on Twitter Monday. "The GOP is back w/ another version of #Trumpcare & it’s no better than their last plan. It’s worse."

The measure would end Obamacare’s requirements that individuals obtain health insurance and most employers provide it to their workers, and give states broad flexibility to address the needs of people with pre-existing medical conditions. The proposal would end the Affordable Care Act’s tax on medical devices while keeping others intact, including taxes on the wealthy, to fund the block grants.

No Democratic support

Because the Graham-Cassidy plan has no Democratic support, Republicans have only until Sept. 30 to push it through the Senate before rules expire that allow it to be passed with 50 senators plus Vice President Mike Pence’s tiebreaking vote. Republicans control the Senate 52-48.

Graham said last week that McConnell said he was “all in” to help the two bill sponsors round up the 50 votes to pass the bill. Graham said they could have as many as 48 votes if the vote were held now. But a number of Republican senators have yet to get on board, including the three who defeated McConnell’s plan -- Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona.

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Senator Rand Paul, a Kentucky Republican, has come out against it, tweeting his opposition Friday and again on Monday.

“No conservative should vote for a rebranded trillion dollar spending program just because it adds some block grants,” Paul wrote Monday on Twitter. He added moments later, “Graham/Cassidy keeps Obamacare and tells the states to run it. No thanks.”

Because the plan keeps most of Obamacare’s taxes, the conservative group Heritage Action is urging Republicans to block it.

McCain undecided

McCain said last week he would consider supporting the plan, but was waiting for input from Arizona’s GOP Governor Doug Ducey. On Sunday, McCain repeated his view that a health plan needs to go through the committee process and gain bipartisan support -- both of which are unlikely with the clock ticking and Democrats united against an Obamacare replacement.

A one-party bill is “not the way to do it,” McCain said on “Face the Nation" on CBS. “The way to do this is have a bill, put it through the committee.”

The Senate Homeland Security and Governmental Affairs Committee has scheduled a hearing for Sept. 26 about health-care block grants.

McConnell has asked the nonpartisan Congressional Budget Office to speed up a financial analysis of the bill, and Democrats in the Senate and House said in a letter Monday that a comprehensive analysis is "essential" before any vote in Congress.

“We expect regular staff briefings and member discussions to continue,” David Popp, a McConnell spokesman, said in an email Monday.

Liberal opposition

Co-sponsoring the proposal with Graham and Cassidy are Chairman Ron Johnson, a Wisconsin Republican, and Nevada Republican Dean Heller.

House Speaker Paul Ryan has spoken positively about the bill, as has Republican Representative Mark Meadows, chairman of the conservative House Freedom Caucus. Still, it isn’t clear that the measure would have enough support to pass the chamber.

Liberal groups including MoveOn.org are working to defeat the plan. The liberal Center on Budget and Policy Priorities said Friday the bill would “significantly” cut federal funding for health coverage over the next decade. It said the cuts would grow more severe in 2027, when the block grants would expire and Medicaid per capita cap cuts would notch down spending. The group estimates that in 2027 alone, federal health spending would decline by $299 billion compared with current law and all states would be affected by cuts.

Credit ratings agency Fitch Ratings said Friday that because Medicaid spending represents one-third of state budgets, the bill would pose big challenges for them, particularly those that took advantage of Obamacare’s Medicaid expansion.

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States ‘at risk’

“States that expanded Medicaid access to the newly eligible population under the Affordable Care Act (ACA) are particularly at risk under this latest bill,” Fitch said. “In the short-term non-expansion states may see gains under the bill given redistribution of ACA related spending streams. But, over time even non-expansion states will face budgetary challenges given the proposed changes to Medicaid, which will likely accelerate for all states over time.”

Republican senators from Medicaid expansion states, including Rob Portman of Ohio and Shelly Moore Capito of West Virginia, are among those who say they’re still reviewing the legislation.

Still, Republicans campaigned on the promise of repealing Obamacare, and many don’t want to give up. They insist the block grants approach in the measure brings flexibility to states that Obamacare lacks. Senator John Cornyn, the No. 2 Republican leader, said last week that he’ll gauge support for the bill, and the topic is expected to be discussed again privately by Senate Republicans on Tuesday.

Graham and Cassidy say that Pence has been telephoning Republican senators and governors. President Donald Trump let the Republican senators know he’s rooting for them, though he didn’t explicitly supporting the legislation.

“I applaud the Senate for continuing to work toward a solution to relieve the disastrous Obamacare burden on the American people,” Trump said in a statement. “Inaction is not an option, and I sincerely hope that Senators Graham and Cassidy have found a way to address the Obamacare crisis.”

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Republicans make last-gasp push to repeal Obamacare

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